Image Fusion System Assisted Ultrasound-guided125-I Seeds Implantion In The Treatment Of Pelvic Metastatic Or Recurrent Malignant Tumor

ObjectiveTo investigate the clinical application of transluminal ultrasound fusing enhanced CT(contrast-enhanced computed tomography,CECT) images guided125I seeds implantationin the treatment of pelvic malignant tumor. We hope it will has good short, medium-termeffect. In the control of local tumor metastasis, recurrence in the absence of bleeding andother complications.(complications of severe myelosuppression associated withconventional chemotherapy and radiotherapy, etc.)MethodsCollecting12cases of pelvic malignant tumor from May2011to January2013, agesfrom36to68, including5cases of male, female7cases, and totally12lesions.6cases ofcolorectal cancer metastasis, which had surgical operation combined with radiotherapy andchemotherapy,3cases of recurrent cervical cancer and ovarian cancer primary tumormetastasis,1cases of chordoma postoperative metastasis;1cases of bladder tumormetastasis;1cases of sacrococcygeal, splenic tumor metastasis;12cases got thepathological diagnosis using ultrasound guided needle biopsy.12cases of percutaneous,transluminal or perineal ultrasound assisted particle implantation,；6cases display not clearthrough transabdominal ultrasonography because of intestinal gas interference or the deeplocation of disease,so we consider the cavity approach for125I particles implantation. Thediameter of tumors ranged from2.8to13.6cm,and the average diameter was5.33cm±3.20(SD, standard deviation). In addition,2cases showed perineal pain, andthe other patients were in good condition without symptoms obviously. Combined with CTimages using TPS (radioactive particles planning system) to make sector plans before theoperation guiding125I seeds implantation treatment, to determine the number of particles,implantation dose distribution and total dose, using the ESAOTE MylabTwice ultrasounddiagnostic instrument, the preoperative MR or CT scan enhanced lesions undergo ultrasound images fusion CT DICOM format images to guide125I seeds implantationtreatment in8cases（4cases of male, female4cases）.4cases (2casesmale,2casesfemale) of image fusion failure, the other2cases due to long time operation only acceptedroutine ultrasound guided brachytherapy. Using TPS planning system before surgerycompared,90%and100%of tumor volume accepted PD, PTV90%,100%PD volumefraction, particle number. All the patients in the treatment had in CECT or CEMRIexamination to evaluate the efficacy, KPS score change, survival rate and tumor controlrate after3months,6months,9months and12months.Results1、all the cases during the operation or postoperation had no serious bleeding,infection or other related complications(complications of severe myelosuppressionassociated with conventional chemotherapy and radiotherapy, etc.), only2cases of patientswith mild abdominal tenderness. Just2cases had a small amount of local bleeding due toapplicator insertion through the small veins. There were no other severe complications occur,such asmassive pelvic bleeding and skin, intestine, bladder radiation injury.2、5cases of abdominal puncture,4cases of rectal puncture,2cases of transvaginalpuncture,1cases of perineal puncture. There were434gold particles, the average received36.16±20.88grains (8～69), the average operation time was65min (45min-85min).3、 After having immediate postoperative unenhanced CT scan, we find the spatialdistribution of tumor implantation are basically consistent with the preoperative TPS plan.The preoperative, postoperative90%,100%tumor volume accepted PD, PTV90%,100%PD, particle number and volume percentage of planned operation implantationparticle number have no obvious difference.4、 Follow-up began after3,6,9and12months (median time was8months) after the125I brachytherapy operation. The control rates of local tumor reached about83.3%,75.0%,50.0%and50.0%, respectively through follow-up after three,six,nine and twelvemonths. Survival rates were100%,91.70%,75.0%,75.0%.5、Preoperative KPS score and after3months of follow-up KPS score has significantdifference (t=-2.727, P＜0.05; z=-2.209p＜0.05).After four months of follow-upKPS score was significantly higher than the preoperative value, the physical condition ofpatients improved significantly after operation3months;3months later, CR4cases (4/12),PR4cases, NC2cases (4/12)(2/12), PD2(2/12), effective rate was66.70%. During1yearof follow-up time,4patients were generally in good condition. No tumor recurrence or metastasis was found.2patients because of blood or extensive lymph node metastasis from6th to12th month during follow-up.1cases with systemic organ failure died in12thmonth.more than4cases with local tumor residue or progress of local lymph node and repeated125I brachytherapy.6、 The survival rate and prognosis: during1year of follow-up,4patients aregenerally in good condition, no tumor recurrence or metastasis was found.2patientsbecause of blood or extensive lymph node metastasis died after6and8months;1caseswith systemic organ failure died after12months, the1year survival rate was75%; theremaining4cases because of the tumor local residual or local lymph node repeated125Ibrachytherapy.ConclusionApplication of CT fusion intracardiac ultrasound images in125I seeds implantation inthe treatment of pelvic malignant tumor is safe in operation. Especially for the lesions inultrasound showed the difficulties. If there is no bleeding and other complications(complications of severe myelosuppression associated with conventional chemotherapyand radiotherapy, etc.)125I brachytherapy has good short, medium-term effects incontrolling tumor local metastasis or recurrence. our research shows that,125Ibrachytherapy is an effective treatment modality for treatment of pelvic metastatic orrecurrent malignant tumor.